Republic 

of the Philippines)
General Santos City ) S.S.
x ------------------------------------ x

AFFIDAVIT OF LOSS

I, YVONNE GAE B. CEREZO, Filipino, of legal age, married, and a resident of

Lower Tapon, Glan, Sarangani Province, Philippines, after being duly sworn in
accordance with law, depose and state:

1. That I was issued with a Passport, with number P4597761B, by the Department
of Foreign Affairs on January 28, 2020;

2. That sometime in May 2022 there was flooding incident in our barangay. Our
houses is one of the damaged or destroyed properties;

3. That due to the above stated incident important documents, including my

PASSPORT, are lost beyond recovery.

4. As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing

and to support my application for the issuance of new PASSPORT, in lieu of the
one that was lost.

IN WITNESS WHEREOF, I have hereunto set my hand this

_________________ in the General Santos City, Philippines.

YVONNE GAE B. CEREZO

Affiant

SUBSCRIBED AND SWORN TO BEFORE ME this ___________________, in

General Santos City, affiant exhibiting to me her UMID No. 0111-7883813-2 as her
competent proof of Identity.

Doc. No. _______

Page No. _______
Book No. _______
Series of 2022.